Psychosocial Health Status of Persons Seeking Treatment for Exposure to Libby Amphibole Asbestos

Introduction

Professional response to the psychological needs of individuals exposed to acute, sudden, and catastrophic natural disasters or terrorism has been the focus of recent research [1] and has become an essential component of comprehensive disaster relief services [2]. However, the human emotional response, resiliency, and potential for chronic psychopathology appear to be different when the disaster is a slow motion, technologically associated event with unremitting long-term impacts on the ecosystem, socioeconomic structure, and health of the resident population [3]. For example, the recent Gulf Coast oil-spill disaster in the United States (USA) provides a glimpse into the lives of individuals and communities dealing with the early stages of psychosocial stress associated with a massive, long-term environmental event. Another case in point, and the focus of this paper, is the delayed psychosocial consequences of a complex and persistent environmental event that is being faced by the community and residents of Libby, Montana in the USA. Libby, a small rural mountain town (population 2600), was contaminated with amphibole asbestos as a result of decades of mining tainted vermiculite ore. In 2002, with the resolve of politicians, medical providers and community members, Libby was placed on the National Priorities List as a superfund site by the United States Environmental Protection Agency (EPA). The community-wide environmental and occupational contamination left Libby with a legacy of economic and insidious health-related problems across generations and a reputation as a place with “air that kills” [4]. In 2009, seven years after designation as a superfund site, the EPA declared Libby a public health emergency, the first in USA history resulting from an environmental disaster under the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). This determination recognized the serious impact to the public health from the contamination at Libby and laid the foundation for a short term grant to provide needed asbestos-related medical care to persons who were exposed to Libby amphibole asbestos. Exposure to microscopic asbestos fibers is linked to several malignant and nonmalignant illnesses including lung cancer, mesothelioma, asbestosis, pulmonary fibrosis, and pulmonary effusions [5]. Persons at risk for asbestos-related diseases (ARD) include (1) former vermiculite workers, (2) household contacts and family members who lived with the workers, (3) community members with no association to the vermiculite mine or mine facilities that lived, worked, or played in Libby, and (4) persons living in other communities across the USA where the ore was processed [6]. During 2000-2001, medical screenings were conducted by the Agency for Toxic Substances and Disease Registry(ATSDR) of 7,307 persons who had lived, worked, or played in Libby for 6 months prior to closing of the vermiculite mine (December 31, 1990). Results showed that 18% of persons had pleural abnormalities [7, 8]. Significant increases in asbestos-related pleural abnormalities were also found among residents living in Libby after 1990 who were never associated with the mining operation. Standardized mortality ratios (SMRs) for asbestosis in persons who lived in the city of Libby and surrounding areas were 40–80 times higher than those for Montana and the USA, respectively [9]. In the latest asbestosis mortality statistics, Lincoln County, where Libby is located, had the highest age-adjusted asbestosis death rate per million people in the USA for residents age 15 and older [10]. As of March 2010, nearly 325 Libby residents have died from ARD; thirty-two deaths have been attributed to malignant mesothelioma, a rare form of cancer most commonly associated with exposure to asbestos [11]. Because ARD has a latency of 10 or more years, more cases are expected to surface [12]. However, the impact of Libby amphibole asbestos (LAA) extends well beyond this rural community. Tainted vermiculite ore was distributed to over 250 processing and distribution plants across the USA, contributing 80% of the world’s supply [13]. It is estimated that the raw ore contained as much as 26% asbestos [7, 14]. Vermiculite is widely used in agriculture, industry, horticulture, and construction [15]. It is estimated that 35 million homes across the USA alone are insulated with the contaminated vermiculite (Zonolite) that came from Libby. The first screening of USA workers exposed to Libby vermiculite products and living outside Libby was carried out in Maryville, Ohio [16] with a follow-up study conducted 20 years later [17]. Pulmonary findings from the Maryville study were similar to the Libby findings from the 2000-2001 health screening. In addition to physical and ecologic damage, technological disasters can affect the psychosocial health of individuals, families, and communities. Anxiety, chronic stress, depression, loss of control, and uncertainty among disaster victims have been documented [18], while communities can be left with an aftermath of controversy, conflict, and social divisiveness [19]. It is reasonable to expect that living with the knowledge of life-threatening risk to health and the potential for continued exposure, as the EPA cleanup activities continue, would increase Libby residents’ vulnerability to depression and stress. While no one is immune, younger age groups and women have been found to be particularly vulnerable to the psychosocial fallout of an environmental disaster [20].